Surgery for Sinusitis

Most patients can be treated without surgery, but not infrequently surgery must be done. Since the primary problem in sinusitis is an obstruction of the drainage of the sinuses, sometimes the blockage needs to be removed. In that case surgery may be the only means to do so.

The most common reason to do surgery is due to failure of medical management after an appropriate period of time. In other words, symptoms persist despite optimal medical therapy. Absolute indications for surgery have been established by the American Academy of Otolaryngology-Head and Neck Surgery and include complete obstruction by polyps, spread of infection or abscess into the brain, the area surrounding the eye, or frontal sinus (Pott's puffy tumor), mucocele, fungal sinusitis, tumor or fluid leak from the brain. Other circumstances depend on whether medical management has been successful.

Surgery is usually done as an outpatient, with most patients going home the same day. The surgery itself usually takes 1-2 hours and a similar amount of time is spent in the recovery room.

Surgery is typically done using a rigid metal endoscope, which allows the surgeon to view the inside of the nose while performing surgery at the same time. An image of the view provided by the endoscope is contained in the image-guided surgery section of this web site.

Surgery is typically done using either local or general anesthesia. When general anesthesia is given, the patient is unable to breathe for themselves, and a tube must be put into the airway to allow the anesthesiologist to breathe for the patient. With local anesthesia, the patient typically is able to breathe by him/herself, but is generally unaware of anything that is occurring. When I had my surgery, I had local anesthesia, and did not remember anything during the procedure except for a few seconds when I was vaguely aware of something going on around me. I was drowsy for several hours afterwards and was not fully awake until the next morning. You may discuss with the surgeon his/her preferences for you regarding anesthesia. Many surgeons prefer to use local anesthesia if it is possible.

Image-guided surgery, discussed elsewhere in this site, may be helpful in situations where complications might otherwise occur because of difficulty with recognizing the usual anatomy. Such is common in the case of frontal sinus disease, or in patients who need to be re-operated.

After surgery is done, you will typically be carefully followed over 4-8 weeks, to make sure that there is no scarring. Crusting will be removed, which can at times be somewhat painful. Many surgeons find that they do not have to use packing after surgery, and consequently reduce the amount of pain with postoperative care. It is not unusual for surgeons to put splints in the nose to keep the nose more open. These are usually removed after a week or so.

Usually patients are given instructions to not fly for several weeks, not lift heavy objects and to put ice over the nose and eyes for the first 48 hours. You will often be instructed to not blow your nose for several days. You will also be given instructions about what to do if you need to sneeze and what to do about your medications. Most sinus medications are not continued in the immediate postoperative period with the exception of decongestants and antibiotics. Your surgeon will typically tell you not to irrigate for a week or so after surgery.

Most patients find that they will sleep for most of the first 24-hour period, and usually be in bed for a few days. It is typically helpful to have someone around for the first several days who can take care of any needs. Most patients end up going back to work after 1-2 weeks.

It is important to make sure that the surgeon you choose has the ability to perform surgery which is complicated. Unfortunately, many otolaryngologists do not have the ability to perform surgery optimally. A surgeon must perform several hundred endoscopic surgeries before the complication rate is minimized. In addition, the surgeon must perform many operations per year in order to maintain skill. The surgeon who performed surgery on me typically does several hundred endoscopic sinus surgeries per year.

It is not unusual for patients to have some amount of pain after surgery, often requiring narcotics. This should diminish rapidly within a few days, so that typically most patients are able to go back to work and resume normal activities after 1-2 weeks. If this does not happen, the reasons should be investigated.

For more information on surgery, please use our search engine below to link to all of the places in this website where surgery is discussed.

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